Rhinoplasty describes a procedure in which the external nasal skeleton, i.e. both cartilage and bone parts, are surgically corrected. Here, mostly congenital malpositions of the nose are corrected (hump nose, saddle nose, crooked nose), but also deformities that have already been caused by nose corrections that have already been carried out can make a new operation necessary. Nose corrections are not always carried out for purely aesthetic reasons, as a correction of the external nasal skeleton can also be justified in the course of traumatically induced nose fractures (due to accidents, etc.).
In the past, women tended to have more frequent nose corrections, but in recent years this trend has changed significantly. Men are also becoming increasingly concerned about their own appearance and therefore decide to have a nose correction. Basically, a nose correction is not covered by the health insurance, but it does make sense to consult a specialist for ear, nose and throat medicine in addition to the plastic surgeon.
There is a simple reason for this, because many people suffer from a curvature of the nasal septum, the correction of this can in most cases be carried out together with rhinoplasty, and in such cases the health insurance company will cover at least part of the costs incurred. Especially the stay in the hospital, the aftercare treatments and the main part of the anesthesia do not have to be paid by the patient himself. Basically, all aesthetic treatments follow the same pattern.
In advance, a consultation is held, then the actual operation takes place and finally the patient is cared for postoperatively. During the consultation, it is important that the patient describes to the doctor as precisely as possible what bothers him about his “old” nose and how the “new” nose should look. It is quite common for patients to bring pictures of their “dream nose” for this reason.
The doctor will then explain any possible complications and, after examining the nose, explain what corrective measures are possible. The thickness of the skin of the nose plays a decisive role here, because with very thick skin it will not be possible to form an extremely narrow, delicate nose, and with very thin skin there is a risk that bone edges will appear after the operation. Many plastic surgeons take photos of the face to demonstrate the possible results of the operation.
However, the patient should be aware that this is only a simulation; even the best plastic surgeon cannot guarantee that the final result will look exactly the same. The actual operation is usually performed under general anesthesia, but it is also possible to use local anesthesia for minor corrections. A nose correction (rhinoplasty) can basically be performed in two different ways, as open or closed surgery.
In most cases, however, the closed surgical method is chosen. In this case the plastic surgeon makes an incision inside the nose (endonasal access). The advantage of this procedure is that there are no scars visible from the outside.
Due to the limited visibility, this method is particularly suitable for less extensive nose corrections, for example for removing humps or straightening crooked noses. If extensive changes are to be made and/or the cartilaginous tip of the nose is to be corrected, an open surgical method is usually unavoidable. In this case, the plastic surgeon will make an incision inside the nose and another incision along the bridge of the nose (between the two nostrils).
Thus, a permanent scar is created, but it is small and in most cases fades very quickly. After the incision has been made, the doctor will lift the skin slightly from the cartilage and bone during both closed and open nose corrections. Now the nasal skeleton can be reshaped.
When the nose is reduced or narrowed (also during hump removal), excess bone and cartilage is now removed. The procedure is somewhat reminiscent of the chiselling work of a stonemason, as the surgeon cuts the bone with a chisel and then brings it into the correct shape. If a nose that is too small is to be enlarged, additional tissue is inserted.
This additional tissue is usually the body’s own cartilage, which is obtained either from the nasal septum or from the ribs.After the modulation is completed, the nose is sutured with a few stitches and its supporting plaster cast is applied (this usually remains on the nasal skeleton for 14 days). Tamponades are also inserted into the nostrils because of the initial bleeding. Since general anesthesia always involves a health risk, it is common for the patient to stay at least one night under observation in the clinic.
The following day, these tamponades are removed and the patient is discharged home, thus entering the post-operative phase. Approximately one week after the operation, another appointment is necessary in the doctor’s office, during this appointment the stitches are removed, as far as they are not made of self-dissolving material, and a new plaster cast is applied. The application of a new plaster cast is somewhat unpleasant, but necessary, since the first swellings of the nose have already subsided and the old cast can no longer provide reliable support.
Usually the doctor will give the patient a view of the “new” nose already at this appointment. It should be clear that the nose is still very swollen at this time and appears much larger than the final result. After a further week, the plaster is finally removed and the nose is treated with a small adhesive bandage.
These adhesive strips can be removed independently by the patient after a few days. Since the nose tends to swell again so soon after the operation, it can be reapplied on its own in this case. Approximately 14 days after a nose correction, the patient is considered “fit for work and social life again”.
At this point, the final result is about 80% visible, the nose needs a long time (up to one year) to completely subside. The final result is only achieved after about one year. A nose correction (rhinoplasty), like any other operation, always involves risks.
On the one hand, there may be rather unspecific consequences, i.e. those that generally occur as a result of any kind of surgery. These include heart, circulation and/or breathing problems during or after the operation. In addition, thromboses can form because of the time spent lying down following the nose correction, or a wound infection can develop due to the surgical incisions.
Particularly with nose corrections, severe postoperative bleeding and sensory disturbances (numbness) of the nose can occur. In addition, most patients develop bruises (hematomas) in the area of the nose, cheeks and especially around the eyes. There may be scar growths within the nose, these growths may obstruct breathing.
A not negligible risk is the depressive moods that occur a few weeks after the operation. This certainly sounds strange at first, because the “new” nose should make the patient happier and more self-confident, but the face draws a person enormously and the face in turn is strongly influenced by the appearance of the nose. The “new” nose now appears strange to many patients at first and they cannot identify with the overall effect of their face for some time.